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I have this prescription sitting in front of me that I'm supposed to start today, and I'm a little freaked-out about it.

My last labs are CD4's 588, 24%, VL undetectable. It's taken 12 years of HAART to get them this high, and now both my ID doc and the RA doc are in agreement that I have the leeway in my numbers to start treatment for my psoriatic arthritis, and they agree that I need to.

The "immunosuppressant" classification alone is making it difficult to jump onboard...let alone the list of possible side effects.

Anyway...I know it's a long-shot, but I thought I would throw it out there, just in case any of you have experience with it.

"At our institution, treatment of patients with severe arthritis with low doses of methotrexate (5 to 10 mg per week) has led to rapid (< 4 weeks) improvement in inflammatory joint symptoms as well as improvement in skin lesions. Methotrexate can be given until the skin and joint disease is under control, then slowly tapered by 2.5 mg per month, aiming for a maintenance dose of 5 mg per week. Patients must be monitored closely, because there are anecdotal reports of progressive immunodeficiency and opportunistic infections in HIV-infected individuals with Reiter's syndrome who are treated with methotrexate. Systemic glucocorticoid use is generally discouraged because of increased risk of infection, but intra-articular steroid injection (every 4 to 6 months) may provide substantial relief to individual arthritic joints."

I think that percentage drop would alarm me too! Is the methotrexate providing you with any relief? I live with a lot of joint pain too, but without an obvious cause as I've tested negative for the things you've tested positive for. (aside from the obvious) The only thing that brings me real relief are cannabinoids - which of course isn't ideal at all. Aside from the illegal aspect, it's exceedingly difficult to get a hold of where I live. There's plenty of heroin on the market here (no, I don't...), but pot, forget about it. I guess it's easier to smuggle heroin over the Irish Sea than smellier pot. I think it's criminal that it's not available here for medicinal use.

But anyway, I hope the stuff is at least giving you relief from the pain and other symptoms that you're dealing with. I've got my fingers crossed for you that you do not experience further drops in your numbers.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

It has helped a bit. The joint pain is still there, but the redness and swelling in my toes seems to be down quite a bit, as is the swelling in the connectivie tissue of the achilles tendon, which was bothering me the most.

I have 4-5 toes that are seriously affected, and that's really what prompted the decision for treatment. Once the joints are damaged, there's no going back (of course), and it happened so fast, and it was affecting my mobility. I wasn't expecting any huge improvement; it's really more of an attempt to curb the progression. It's too soon to tell if it's actually doing that.

The RA doctor isn't head-over-heels enthusiastic about the drug methotrexate, but it's really the first line of treatment. He would like me on weekly Enbrel injections, but most insurance (including mine) won't approve Enbrel until you've tried and failed with one of the cheaper medications. (I looked up Enbrel at my mail-order pharmacy website--a 3 month supply is over $4,000...I about fell off my chair.) Enbrel is also an immunosuppressant, though, so it would likely be doing the same thing to my numbers.

I'm just going to stick with the methotrexate for now, and keep a close watch on my numbers. My VL is still undetectable, so that's good, and 19% isn't bad (I was diagnosed at 4%). I don't pay too much attention to CD4's until they get dangerously low.

Like I said...it's just a bit disconcerting to see them fall so fast after it took so very long to build them up.